11 Questions for a Pediatric Physical Therapist

A pediatric physical therapist specializes in treating and caring for infants, toddlers, teenagers and young adults, and can treat conditions related to genetic, neurological and orthopedic disorders. In this Q&A, Daniel Santioni, Director of Pediatric Services, Probility Physical Therapy, answers some of the most common questions parents have about their child’s development.

1. 1. What kind of physical therapy does a young baby under 6 months need?
      
      Physical therapy (PT) can address several issues that are common under 6 months. In fact, early diagnosis and treatment is key to continued success in growth and development. Often PT at this age can address delay in motor skills, orthopedic concerns such as joint deformity or torticollis, feeding concerns and their inability to self-console.
   2. How do you know if a baby under 6 months is delayed?
      
      Often experienced mothers and fathers know that “this” baby is just not doing the same things their other babies did. First-time parents should pay attention to published milestones they may find at their doctor’s office. There are standardized tests to evaluate for delay, but generally, by 6 months your child should be rolling and working on maintaining sitting by themselves.
   3. I feel my child is impaired. I am an experienced parent and I know something is wrong. My child is only 8 months old, but what can I do?
      
      The first thing you should do is address your concern with your doctor. Asking for a pediatric therapy referral would be a good start in trying to figure out if there is anything wrong. Your physical therapist can perform developmental , orthopedic and neurological testing to assist with any diagnosis your doctor may want to pursue. Physical therapy can often help prioritize what to focus on in terms of treatment, and help you stay focused on what you can do to help your child succeed.
   4. My baby is having a hard time feeding – they are biting instead of sucking. It takes them a long time to feed, and my baby seems exhausted after feeding. Can physical therapy can help me with this issue?
      
      Feeding issues and concerns are common with a young infant. Often biting or chomping instead of sucking may mean there is a physical restriction to the normal suck, swallow and breathe pattern. A physical therapist can address the physical restriction to mouth opening and closing, and can help steer you to other professionals, such as a speech or occupational therapist, who can focus on teaching the normal feeding pattern.
   5. My baby just turned 12 months old and is not walking or even pulling up to stand. Should I be worried?
      
      Pulling up to stand at a surface is a 9-month skill and taking the first few wiggly steps is a 12-month skill. Having said that, you must remember there is a range in which development is “normal.” Not all children walk at 12 months. With walking there is a “normal” range of 11-14 months. Pulling to a stand also has a “normal” range of 8-11 months. If your 12-month-old child is not pulling to stand, a physical therapy evaluation may be warranted. You may find, with the right intervention, your child may catch up very quickly.
   6. I have been told my child has Torticollis – is this permanent and how can physical therapy help?
      
      Torticollis is usually due to tight neck muscles which prevent the baby from turning their head in one particular direction. Physical therapy is a very successful tool in resolving torticollis through gentle stretching and developmental play. The sooner torticollis is addressed, the faster it is resolved. Torticollis, if caught in time, usually is not permanent.
   7. My child had torticollis and they look better. Now I notice their head is not round. Can therapy help this?
      
      If your child had torticollis, the resulting misshaped head is called plagiocephaly. Physical therapy can address this through positioning, developmental play and manual techniques. If the misshaped head is not corrected in 4 to 5 months, the recommendation is to get a helmet to assist in reshaping your child’s head. This would require you to meet with an orthotist to fabricate and do frequent fittings of the helmet.
   8. My child is 3 years old and has walked on their tip-toes since they started to walk. Everyone is telling me they will “outgrow” this. How long do I wait before I get help, and what kind of help can I get for this?
      
      Generally, as children learn to walk, for the first few months (12-18 months) they will “play” with coming up on their toes. This means they may walk flat-footed for a few steps then up on toes for a few and then back down. If your child is exclusively toe walking after the age of 18-24 months, I would recommend bringing this to the attention of your physician and get them into physical therapy. A pediatric physical therapist can help figure out why the child is toe walking. Once the evaluation is completed, the physical therapist will provide a combination of stretching and strengthening exercises to get your child walking in a normal heel-toe pattern.
   9. My child has been toe walking for years and is now “stuck” on their toes. They cannot at all get their heels on the floor. The doctors are looking at referring me to a surgeon. Can physical therapy help me now?
      
      Working with your doctor, a physical therapist may still be able to help in this situation. Being “stuck” on their toes may mean that their heel cord is contracted. A physical therapist can provide a treatment called serial casting. This would involve casting the ankle and progressively lengthening the heel cord until they can move their ankle again in all directions. Once the ankle is loosened the physical therapist can then address strengthening and retraining your child how to walk with heels down.
   10. When observing other children on the playground, I am noticing my child is always falling. They are usually asking the other kids to wait for them, and at times just doesn’t want to participate. As a parent, I often wonder if there is anything I can do to help. Can physical therapy help?
       
       A pediatric physical therapist can perform standardized testing to see if your child is truly developmentally behind. If your child is delayed, the physical therapist will design a custom program to address the areas of development to help your child “catch up” with their peers.
   11. My 9-year-old son broke his leg. He was casted and is favoring that leg. Everyone said he would be fine, and told me to encourage him to just be himself. No matter what I try, he resists. Can physical therapy help with this?
       
       Yes, often after being casted, muscles become weak, tight and need physical therapy to get strong again. Often children have a fear factor to overcome as well. The pain that they experienced at the time of the injury can affect them for a long time. A physical therapist can help your child physically work out his fear while strengthening his leg. The goal of physical therapy would be to normalize his walking pattern and eliminate this “favoring” of one leg over the other.

Dan is accepting established and new patients at Probility Physical Therapy, 2058 S. State Street, Ann Arbor, MI 48104. Call 734-913-0300.